Coding Resource Center
August 2022
The Centers for Medicare and Medicaid Services (CMS) has released a Request for Information soliciting feedback regarding the Medicare Advantage program. Comments are requested from providers, plans, beneficiary advocates, states, employers and unions, and other partners to assist with policy development and implementation. “Medicare Advantage is a critical part of CMS’ vision to advance health […]
On Tuesday, August 17, the President signed the Inflation Reduction Act bill into law. The $750 billion health care, energy and climate bill which was passed by the House and Senate last week, contains many major health policy changes, including: Giving Medicare the power to negotiate prescription drug prices and extend expiring health care subsidies […]
On August 18, the Centers for Medicare and Medicaid Services (CMS) released several fact sheets aimed at helping providers prepare for the end of the COVID-19 public health emergency (PHE). CMS has been influential in supporting the health care community and its beneficiaries during the COVID-19 pandemic, offering emergency waivers and other regulations and enforcement […]
July 2022
On July 7, 2022, the Centers for Medicare and Medicaid Services (CMS) issued the proposed rule for the Medicare Physician Fee Schedule (MFPS). These proposed rules cover physician services furnished to beneficiaries on or after January 1, 2023. Highlights are described below: CMS proposed Conversion Factor (CF) of $33.0775, which includes omission of the 3.00 percent […]
On July 15, 2022, the Centers for Medicare and Medicaid Services (CMS) issued the proposed rule for the Medicare Hospital Outpatient Prospective Payment System (HOPPS) and Ambulatory Surgery Center (ASC) Prospective Payment System. These proposed rules cover outpatient hospital and ASC services furnished to beneficiaries on or after January 1, 2023. Highlights are described below. […]
On July 15, 2022, Xavier Becerra, Secretary of Health and Human Services (HHS) announced the renewal of the public health emergency (PHE) declared due to the Coronavirus Disease 2019 (COVID-19). The PHE was originally declared on January 31, 2020; and renewed on April 21, 2020, July 23, 2020, October 2, 2020, January 7, 2021, April 15, […]
On July 1, 2022, the Centers for Medicare and Medicaid Services (CMS) Insurer Price Transparency Rule enforcement went into effect. It was intended to be in effect as of January 1, 2022, but CMS delayed enforcement for six months to allow payers time to adhere to the regulations, including access to machine-readable files for consumer […]
On July 7, 2022, The Centers for Medicare and Medicaid Services (CMS) issued Change Request (CR) 12769 to suspend outpatient and inpatient prospective payment system (OPPS and IPPS) claims getting an outlier payment when a device credit is reported. This edit will allow Medicare Administrative Contractors (MACs) to review the charges and validate Medicare outlier […]
June 2022
On December 10, 2021, the Protecting Medicare and American Farmers from Sequester Cuts Act was passed, which impacts payment for all Medicare Fee-for-Service (FFS) claims. This law covered a continued suspension of 2 percent sequestration through March 31, 2022, and subsequently a 1 percent payment adjustment from April 1 – June 30, 2022. For July […]
The Centers for Medicare and Medicaid Services (CMS) issued the proposed rule for the Medicare End Stage Renal Disease (ESRD) Prospective Payment System (PPS). These proposed rules cover renal dialysis services furnished to beneficiaries on or after January 1, 2023. Highlights are described below: Rebase and revise the ESRD market basket to a 2020 base […]
